ABSTRACT
Clinical aspect: Approximately 3 weeks (incubation may range from 3 to 90 days) after the initial exposure, a chancre appears at the spirochetal portal of entry, mainly corresponding to the vulva or cervix in females. In 10% of cases, extragenital sites (including the anus, oropharynx, tongue, nipples, and fingers) may be affected. This is classically a single, reddish, firm, often eroded, painless and nonitchy nodule, with a clean base and sharp borders, between 0.3 and 3 cm in size (Figures 9.1.1 through 9.1.4). The chancre may sometimes show a central deeper ulceration with slightly elevated edges or be multiple in some patients. It may go unnoticed if it occurs in the inner part of the vagina or at the cervix. This lesion is highly infectious, oozing a serum that is rich in vital spirochetal organisms. Coexistent regional lymphadenopathy is typical. Inguinal adenitis is usually unilateral or, less often, bilateral, discrete, firm, mobile, and painless, without overlying skin changes. Single, sharply defined, reddish, firm and eroded nodule: chancre (primary syphilis). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429160967/163b7f5e-cc4b-49c3-bdf2-114d4fa08aec/content/fig9_1_1.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/> Firm nodule with sharp edges and shallow central ulceration: primary syphilis. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429160967/163b7f5e-cc4b-49c3-bdf2-114d4fa08aec/content/fig9_1_2.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/> Primary syphilis in a dark-skinned patient. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429160967/163b7f5e-cc4b-49c3-bdf2-114d4fa08aec/content/fig9_1_3.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/> Primary syphilis in a dark-skinned patient. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429160967/163b7f5e-cc4b-49c3-bdf2-114d4fa08aec/content/fig9_1_4.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/>
